After two back surgeries, Patty Casey, whoworks part time as an assistant in Univer-sity School of Jackson’s cafeteria, found

herself with debilitating pain.She sat down in her recliner at home, and she

couldn’t move her legs. Her husband had to carryher to bed.

She went to West Tennessee Bone & JointClinic to see Dr. Eric Jon Homberg, a board-certified anesthesiologist who specializes in the rel-atively new field of interventional pain manage-ment. He uses a multimodal and balancedapproach to treating patients with the prescriptionof therapies, medications and minimally invasiveprocedures to help with recovery and pain man-agement.

He has pursued addi-tional training in new andinnovative procedures toprovide patients with ad-ditional choices.

“I went in with awheelchair, and he’s got mewalking and working,and I feel goodmost days,”Casey said.

Dr. Homberg administered three or fournerve-block injections to manage her pain andprescribed pain medication, she said. She visits theclinic every two or three months for a checkup. “Iam walking and enjoying life pain free.”

Dr. Homberg primarily treats patients withinjection procedures aided by fluoroscopy — in-termittent X-rays and ultrasound — to delivermedications to the source of the pain without im-pacting the rest of the body. He said a successfulapproach to pain management is a balanced regi-men of physical therapy, procedures to managepain, medications and surgery when appropriate.

Because a variety of pain management tech-niques are associated with interventional painmanagement, patients don’t have to rely as heavilyon narcotics to bring their pain under control.

Casey had her first back surgery in 2011 andher second in 2012. She said she couldn’t get over

the constant pain in her legs andback. At times, it was so severe

that she couldn’t move.But thanks to Dr.

Homberg and interven-tional pain management,she said her quality oflife has greatly improved.

“I feel good,” Caseysaid. “I am very

thankful tohave him asmy doctor,and I highlyrecommendhim and hisservices.”

Active

Keeping you...

Keeping you...

Active… is a quarterly

newsletter from West

Tennessee Bone & Joint

Clinic. The clinic’s 12

physicians specialize in

sports medicine, hand

injuries and disorders,

orthopedic diseases and

musculoskeletal injuries,

and interventional pain

management. For copies of

this newsletter, contact

Adam Kelley, Marketing

Director, 731.661.9825.

Like us on Facebook!

Read more …n Youth baseball, softballinjuries increasing

n Hip mobility and hiparthroscopy

n Proper stretchingimportant

n Patients thank physiciansfor treatment

Spring 2014

Active

731.661.9825 n 888.661.9825 n www.wtbjc.com

Interventional pain managementhelps patient after two surgeries

Dr. Eric Hombergwith patientPatty Casey

Congratulations to Dr. David Johnson forbeing selected as a

Jackson Sun Readers'Choice favorite

orthopedic surgeon!

Youth baseball and softball is changinginto a year-round sport with the growthof youth travel leagues.

Instead of a season in spring or early sum-mer that lasts a couple of months, many kidsplay longer, and that means they are exposed tothe possibility of more injuries — especiallywith pitchers, said Dr. Harold Antwine, aboard-certified orthopedic surgeon with WestTennessee Bone & Joint Clinic.

“What I’ve seen more and more with thesekids is a lot of elbow and shoulder injuries,” Dr.Antwine said.

His son, 12-year-old Brooks, plays for atravel team in Mississippi. Dr. Antwine is famil-iar with the pitching regulations created to pro-tect young athletes. However, the leagues usethe wrong metric because they typically cap thenumber of innings a pitcher can throw, he said.

“I think all of youth baseball needs to movetoward pitch counting. It’s the volume ofpitches — not the number of innings.”

Anyone familiar with baseball knows apitcher can generate an out with only onepitch. However, an at-bat can easily soar tomore than 10 pitches with a full count and aslew of foul balls. One pitcher can getout of an inning with a handful ofpitches while another could throwdozens.

In the Major Leagues, Dr.Antwine noted, managers will restpitchers for several days after theyreach a certain pitch count. It allowsthe damaged tissue around theshoulder and elbow to heal andincreases a player’s longevity.

High pitch counts, re-gardless of the number of in-nings it takes a pitcher to getthere, can lead to tendonitisand fractures in young playerswith open growth plates, Dr.Antwine said. And if a playercontinues to pitch whilehurt, his career couldbe cut short before hereaches high school.

“They can dosome irreversible, permanentdamage by continuing to pitch,” Dr. Antwinesaid.

And until their growth plates close,

which happens at ages 16 or 17 with boys andages 14 or 15 with girls, pitchers should avoidthrowing breaking balls and curve balls, hesaid. Instead, they should stick with fastballsand changeups.

Dr. Antwine’s young patients usuallycome in complaining of pain or discomfortwhile pitching. The treatment prescribed istypically rest and maybe some Ibuprofen,though Dr. Antwine will order an X-ray if nec-essary to determine if there is a fracture.

In many cases, the kids can return to playquickly, as long they play a different positionuntil their pitching arm heals.

Some patients require physical therapy tostrengthen their injured arms. In rare cases, apatient will have a fracture and need a cast. Ifthe injury caused a significant amount of dis-placement, surgery could be required to installpins and/or screws.

Youth baseball, softball injuries increasing as more play year round

Dr. Harold Antwine,at right, observes hisson, Brooks, pitching

in a game.

Regulations for regular season andtournament play:w Pitchers cannot pitch more than 10 innings on consecutivedays.

w If a player pitches at all in any inning, the appearance countsas a full inning.w If a player is pitching in a tie game at the end of regulationplay, he may finish the game regardless of the number of

innings pitched. However, he can only continue if he did not pitchthe previous day or in the first game of a double-header on the

same day.w If a game is called due to weather or any other reason, the number of

innings pitched will count against the pitcher.

Regulations for pitchers in Junior Division baseball,softball:w Pitchers cannot pitch more than 12 innings in a calendar week.w Pitchers cannot pitch more than seven innings in a single day.w After pitching four or more innings in any one game, the pitcher must haveat least two days rest before he or she can pitch again.

w If a pitcher pitches to any batter, the pitcher is charged with an inning.w If removed as a pitcher, the player can play any other position.

If you have pain in yourhip, you may have a condi-tion called femoroacetabular impingement

(FAI). In simpler words, this means the ball ofyour thigh bone or femur does not have a fullrange of movement in your hip joint.

Most often, FAI is caused by excess bonethat has formed around the head of the femur.

Physicians at West Tennessee Bone & JointClinic will first look at non-surgical treatmentto reduce the pain and swelling in your joint.FAI often can be resolved with rest, modifyingone’s behavior and a physical therapy and/oranti-inflammatory regimen.

When that does not work, however, sur-gery may be necessary. Traditionally, surgeonshave corrected the problem through an openincision near the joint.

However, Dr. Adam Smith and I have re-ceived special training in a better surgical ap-proach to this problem — hip arthroscopy,which is less invasive and easier on the patient.While open surgery requires a longer hospitalstay, arthroscopic surgery is an outpatient pro-cedure. The patient goes home the same day.

We now regularly treat FAI with arthro-scopic surgery and have good results. In fact,after hip arthroscopy, many patients return tothe level of physical activity they had beforethe problem occurred.

FAI is often the result of normal bonegrowth and development. The extra bone canappear on x-rays as a small “bump.” However,when the bump repeatedly rubs against thecartilage, the cartilage can fray or tear, result-ing in pain. As more cartilage is lost, arthritiscan develop.

Tears of the labrum (cartilage on the out-side rim of your hip joint socket) also can foldinto the joint space, further restricting motion

of the hip and causingmore pain. This is similarto what occurs in the kneeof someone with a tornmeniscus.

Other causes of theproblem include falling onone’s hip and athletic activ-ities that involve repetitivepivoting movements orrepetitive hip flexion.

Impingement can pres-ent at any time betweenthe teenage years and mid-dle age. Many people firstrealize a pain in the frontof their hip (groin) afterprolonged sitting or walk-ing. Walking uphill alsomay be difficult. The paincan be a consistent dullache or a catching and/orsharp, popping sensation.

With hip arthroscopy,we make two to threesmall incisions — aboutone-fourth to one-halfinches long. We insert thesurgical instruments intothe joint through these in-cisions.

Our instruments include an arthroscope,which is a long thin camera that allows us toview the inside of the joint, and a variety of“shavers” that allow us to cut away the excessbone or tissue. Specialized implants allow us torepair torn labral tissue, as well. Flushing salinethrough the joint helps to give us a good view

of the surgery.After the procedure, pa-

tients normally are givencrutches to use for the firsttwo to four weeks to mini-mize weight-bearing. Thepatient normally begins aphysical therapy regimen toimprove strength and flexi-bility in the hip.

After six weeks of physi-cal therapy, many patientsbegin to resume more nor-mal activities, but it maytake three to six months be-fore they experience nosoreness or pain after stren-uous physical activity.

We determine whetherpatients are suitable for hiparthroscopy on a case-by-case basis. Those who re-spond best to hip arthro-scopy are active individualswith hip pain, where an op-portunity exists to preservethe cartilage they still have.Patients who have alreadysuffered significant cartilageloss in the joint may be bet-ter suited for a more exten-sive operation, such as hipreplacement.

Studies have shown that 85 to 90 percentof hip arthroscopy patients return to sportsand other physical activities at the level theywere at before their onset of hip pain and im-pingement. The majority of patients clearly getbetter, but it is not yet clear to what extent theprocedure stops the course of arthritis.

Proper stretching is a vital yetoften overlooked component ofwarming up before participation in

athletic activities.Stretching is an important tool in manag-

ing common muscle imbalances that oftenoccur in a young athlete’s growing body. Flexi-ble joints require less energy to move througha greater range of motion, which decreasesoverall risk of injury while improving physicalperformance.

The goal of stretching is to strengthenmuscles and surrounding tissue safely and ef-

fectively. Flexibility training has two basicmethods.

w Dynamic stretching involves using dy-namic movements to take a muscle or jointthrough its full range of motion without hold-ing a sustained stretch at any point.

When performed correctly, dynamicstretching warms up joints, maintains currentflexibility and reduces muscle tension. Studieshave suggested that this method of stretchingis best prior to any sports-related activity.

w Static stretching involves taking aspecific joint through a normal range

of motion to a comfortable end point. Thisstretch is held for about 10 to 20 seconds.

Static stretches are useful after playing asport once muscles are well heated. Thesestretches help increase blood flow and preventbuildup of lactic acid, which results in musclesoreness and cramps.

An appropriate stretching program shouldbe a part of every athlete’s daily exercise rou-tine. After all, no one wants a season cut shortdue to a preventable injury.

Proper stretching important for young athletesBy Marty Grooms, Occupational Therapist

By David Pearce, M.D.

Hip mobility and hip arthroscopy

e hip is a ball-and-socket joint.e socket is formed by the acetabu-lum, which is part of the largepelvis bone. e ball is the femoralhead, which is the upper end of thefemur (thighbone). A slippery tissuecalled articular cartilage covers thesurface of the ball and the socket. Itcreates a smooth, low-friction sur-face that helps the bones glide easilyacross each other. e acetabulum isringed by strong fibrocartilagecalled the labrum, which creates atight seal around the socket andhelps to provide joint stability.

(www.aaos.org)

Lowell Stonecipher, M.D.

Michael Cobb, M.D.

David Johnson, M.D.

KellyPucek, M.D.

HaroldAntwine III, M.D.

DavidPearce, M.D.

JasonHutchison, M.D.

AdamSmith, M.D.

J. DouglasHaltom, M.D.

EricHomberg, M.D.

JohnEverett, M.D.

MichaelDolan, M.D.

Donna Klutts, CMPEChief Executive Officer

Keeping You ActiveThe physicians at West Tennessee Bone & Joint Clinic, P.C. specialize in comprehensive orthopedic care

for adults and children and interventional pain management. This includes sports medicine,

hand injuries and disorders, orthopedic diseases and musculoskeletal injuries.

They see patients in …Jackson • Brownsville • Selmer • Lexington • Parsons • Dyersburg • Union City • Bolivar • Ripley

24 Physicians Drive, Jackson n 731.661.9825 n 888.661.9825 n www.wtbjc.com

Susan Elvington came to West TennesseeBone & Joint Clinic in 2009 for a total

knee revision after a previous knee-replace-ment surgery in 2003.

She said her experiencewith Dr. Jason Hutchison andthe entire staff at the clinic has

been very positive.Everyone has been

helpful through theprocedure, rehaband subsequentfollow-up visits,she said.

“e peoplethere are great to dealwith – from the frontdesk all the way backto the rehab depart-ment.”

Jackie Collins, an activities director at anursing home, saw Dr. Michael Cobb after she injured her anterior cruciate lig-

ament several monthsago at work.

She said her ex-perience at WestTennessee Bone &Joint Clinic,from the frontoffice to thenurses andphysicaltherapists,has beengreat.

“Theywere veryhelpful,” Collins said. “They explained things. They were nice. Igot in in a timely manner, and everything was just lovely.”

Patients thank physicians for treatment

Marketing Director Adam Kelley with Susan Elvington

Jackie Collins with Dr. Michael Cobb